The U.S. military lives by the rule: “Leave no soldier behind.” The Walter Reed Army Medical Center (WRAMC) seems to have operated according to a different principle: “Out of sight, out of mind.”

It is unconscionable for a government to send soldiers to fight, die, and suffer life-changing wounds without assuring them first-class medical care and rehabilitation should they require it because of their service. Government should also provide injured soldiers with the financial resources for a decent standard of living, consistent with the severity of wounds suffered. The recent media revelations of the medical care at Walter Reed, particularly for returning soldiers billeted in outlying buildings, demonstrate that the U.S. government has broken this social compact.

This is not a question of malice aforethought, either by the government or the hospital. The sins of Walter Reed were those of omission, not commission. But sins they remain, and the U.S. government must do more than just fire a few people and rehab a few buildings.

Lack of Care

The description of the squalor in which some wounded veterans lived – notably in the now infamous Building 18 – was a surefire journalistic hook to draw the reader into the full story. This is not a criticism but an observation about the power of solid reporting of indisputable facts. The Washington Post reporters exposed not only the living conditions – easy to fix if the responsible authorities put their minds to it – but also the more serious implications for the physical and mental recovery of those who become part of the WRAMC “family.”

The medical side of the care provided in the main hospital is not in question. But other parts of the total patient experience failed. Patients not in the main hospital building simply fell out of the administrative loop.

When a soldier is in the multi-story main hospital building as an in-patient, most of the medical and medical-support actions are either automatically done or readily accessible to patients. Doctors come onto wards; nursing staff is available and checking on patients around the clock; chaplains make daily rounds; a mobile library can be encountered in the hallways moving from room to room; physical therapists administer post-injury rehabilitation; and volunteers visit those unable to get out of bed.

What seems to have happened to those not in the main building is as understandable as it is inexcusable. This in-patient support structure – or at least some critical parts of it – didn’t exist or was wholly inadequate. It didn’t provide services for those in the disconnected housing facilities on the WRAMC grounds or – as in the case of Building 18 – in the facilities outside the gates and across a multi-lane transportation artery running into downtown Washington.

The situation worsened as the number of casualties from Iraq and Afghanistan mounted. And this number increased much faster in these wars because improved medical procedures meant that more troops survived their wounds. In addition, because of the privatization of many positions, the number of federal employees fell from 600 to 60. As a result, a certain triage took place in which patients in the main building were treated as “in-patients” while everyone else, including those in different WRAMC buildings and those living outside of Washington, became “out-patients.” Once soldiers entered this latter population, they received less monitoring and less care.

From that point on, it was all down hill for the wounded troops. Down hill, that is, until the conditions were exposed to the public and the Congress.

Public Outcry

But then, inexplicably, the Army goes and shoots itself in the foot. Commanders exhibit inexcusable indifference or blame shifting, troops reportedly are muzzled and threatened with reprisals. Then it becomes apparent that senior noncommissioned officers, officers, and even commanding generals had known about the shortcomings in staffing, in the level of services provided to the patients assigned to their care, and in the conditions in which some of the wounded lived and functioned.

At this point, for whatever combination of reasons, it was evident that the chain-of-command had failed its fundamental challenge: leadership. Accountability dictated that heads would roll. To date, one Secretary of the Army is gone; one general officer – ironically the only senior army official to apologize publicly – has been relieved; one company grade officer has also lost his position; a sergeant-major and a number of platoon sergeants have been “moved”; and a 120-person medical support unit has been assigned to Walter Reed to straighten out the place.

Unfortunately, many returned wounded veterans are struggling with the same conditions in under-funded and under-staffed army and veterans’ hospitals elsewhere in the country.

The “bricks and mortar” side will be repaired first because it is the easiest to do. Unfortunately, as the most visible, it is also potentially the most deceptive measurement of progress made in rectifying the shortcomings not only at WRAMC but in all Defense Department hospitals and clinics.

Moreover, Congress must look at the Veterans Administration (VA) health care system. This system is under tremendous strain as it tries to cope with the 5.5 million veterans seeking medical attention every year in one of the 1,050 VA hospitals, medical centers, and clinics. It is true that the VA budget has increased significantly under President Bush, but those increases are projected to end after 2008, falling back in 2009 and 2010, and then holding steady – precisely when its resources will be in greatest demand by returning service members.

The Bush Legacy

Already, more than 1.5 million men and women have served in Iraq and Afghanistan, and more will go. But they will not be this administration’s problem. President Bush has already told the public that when he leaves office in January 2009, he fully expects to bequeath his successor two ongoing wars in Afghanistan and Iraq. He will also dump on his successor and future generations of Americans the long and costly obligation to care for and help heal lives destroyed by these wars.

Reading between the lines of recent Pentagon testimony before Congress on future budgets seems to confirm what the “old hands” have alleged for years: that there never was any serious thought given to a Plan B for Iraq in case Plan A failed. Well, it is also now very apparent that the administration never had a Plan A – let alone a Plan B – for the medical systems of either the Defense Department or the VA.

Thus, a medical care system established to treat and care for those who return from war physically or mentally injured by the experience is under-staffed, under-trained, under-resourced, and unprepared. In fact, the military-veterans medical treatment system, highly bureaucratic in its origin, has become so convoluted that patients get lost in the system, especially when an individual moves from active to veteran status. Why? Because the VA and DOD computers with individual medical records are unable to routinely access medical treatment histories or transfer data from the other department’s computers.

War is hell, no doubt. As the Walter Read case reveals, however, the aftermath of war also has its own horrors. And many of these horrors last a lifetime.

Dan Smith is a military affairs analyst for Foreign Policy In Focus (www.fpif.org), a retired U.S. Army colonel, and a senior fellow on military affairs at the Friends Committee on National Legislation. His blog is "The Quakers' Colonel" http://quakerscolonel.blogspot.com/.